Provider Demographics
NPI:1750578704
Name:PATHOLOGY ASSOCIATES LABORATORY
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:GEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-387-6631
Mailing Address - Street 1:312 GRAMMONT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7457
Mailing Address - Country:US
Mailing Address - Phone:318-387-6631
Mailing Address - Fax:
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-387-6631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01969R291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA18117Medicare PIN